Probiotics and Gut Health

Probiotics have gained substantial attention in recent years for their potential benefits in gut health. As living microorganisms that confer health benefits to the host, probiotics can play a crucial role in maintaining and restoring gut flora balance (helping treat gut dysbiosis).

But before you go out and buy an expensive probiotic supplement, I want you to understand what probiotics really are, when you should and shouldn't take them, that different probiotics can be used for different things, and of course.... FOOD COMES FIRST! 

What Are Probiotics?

Probiotics are beneficial bacteria (and yeast) that, when consumed in adequate amounts, offer health benefits, primarily by enhancing or restoring the gut microbiota (helping to eliminated gut dysbiosis). The most commonly used probiotics include strains from the Lactobacillus and Bifidobacterium genera, as well as the yeast Saccharomyces boulardii - This little bugger is my personal favorite!

Benefits of Probiotics for Gut Health

1. Restoring Gut Microbiota Balance: Probiotics can help restore the natural balance of gut bacteria, which can be disrupted by factors such as antibiotic use, poor diet, and stress. A balanced microbiota is crucial for effective digestion, nutrient absorption, and immune function (Ng et al., 2014). Gut dysbiosis occurs when there is an imbalance (often bad guys outweigh the good guys) and can cause issues like bloating, constipation, fatigue, brain fog, anxiety, mood disorders, skin issues, increased inflammation and immune responses. 

2. Supporting Immune Function: The gut is a major component of the immune system. Probiotics can enhance the gut's immune response by stimulating the production of IgA (an antibody that is a key part of the immune system) and enhancing the activity of macrophages (a type of white blood cell that eats the bad guys) and T cells (another type of white blood cell) (Oelschlaeger, 2010).

3. Reducing Gastrointestinal Disorders: Probiotics have been shown to alleviate symptoms of various gastrointestinal disorders, including Irritable Bowel Syndrome (IBS), Inflammatory Bowel Disease (IBD), and diarrhea, particularly antibiotic-associated diarrhea (Vanderhoof & Young, 2008). Probiotics are also useful in the treatment of candida overgrowth and elimination of H. Pylori. 

4. Preventing and Treating Infections: Probiotics can inhibit the growth of pathogenic bacteria by producing substances like lactic acid and bacteriocins, competing for nutrients and adhesion sites, and enhancing the gut barrier function (Sanders, 2011).

When Should You Avoid Probiotics?

While probiotics can offer significant benefits, they are not suitable for everyone. Situations where probiotics might not be recommended include:

1. Immunocompromised Individuals: People with weakened immune systems, such as those undergoing chemotherapy, organ transplant recipients, or individuals with HIV/AIDS, should use probiotics cautiously due to the risk of infections like fungemia and bacteremia (Besselink et al., 2008). Check with your healthcare professional to make sure it's okay. 

2. Critically Ill Patients: In critically ill patients, particularly those in intensive care units, probiotics may pose a risk of sepsis or other severe infections (Besselink et al., 2008).

3. Severe Pancreatitis: Probiotic use in patients with severe acute pancreatitis has been associated with increased mortality and should be avoided (Besselink et al., 2008).

Specific Probiotics for Different Health Conditions

1. Irritable Bowel Syndrome (IBS):

   • Bifidobacterium infantis: Shown to reduce symptoms like abdominal pain, bloating, and bowel movement irregularities in IBS patients (Whorwell et al., 2006).
   • Lactobacillus plantarum 299v: Effective in reducing abdominal pain and bloating in IBS (Nobaek et al., 2000).

2. Inflammatory Bowel Disease (IBD):

   • VSL#3 (a multi-strain probiotic): Proven beneficial in maintaining remission in ulcerative colitis and preventing pouchitis (Mimura et al., 2004).

3. Antibiotic-Associated Diarrhea:

   • Saccharomyces boulardii: Effective in reducing the incidence and duration of antibiotic-associated diarrhea (McFarland, 2010).
   • Lactobacillus rhamnosus GG: Helps prevent antibiotic-associated diarrhea and Clostridium difficile infections (Szajewska & Mrukowicz, 2005).

4. Traveler’s Diarrhea:

   • Saccharomyces boulardii: Can prevent traveler’s diarrhea and reduce its duration (Kollaritsch et al., 1993).

5. Acute Diarrhea in Children:

   • Lactobacillus reuteri: Shown to reduce the duration of acute infectious diarrhea in children (Shornikova et al., 1997).

Food as Medicine

 So where can you get probiotics naturally? Fermented foods! Eating a wide variety of fermented foods helps to make sure you are getting a wide variety of good bacteria. For example, Sauerkraut contains Lactobacillus and Bifidobacterium spp. Kefir has Lactobacillus, Bifidobacterium, Streptococcus, Saccharomyces. Kimchi contains Lactobacillus and Bifidobacterium. 

Other probiotic foods include yogurt, miso, tempeh, pickles.... again fermented! 

Add a little bit to each meal. With probiotics and fermented foods, you want to start slow otherwise you'll end up with more bloating and discomfort.

Conclusion

Probiotics are important for gut health and managing various gastrointestinal conditions. However, it is essential to select the appropriate strains for specific conditions and be mindful of situations where probiotics might not be suitable. As a functional medicine practitioner, I always recommend food first and using food as medicine. So, try out a little miso or kefir this week and your gut will thank you. 

References:

• Besselink, M. G., van Santvoort, H. C., Buskens, E., Boermeester, M. A., van Goor, H., Timmerman, H. M., ... & Gooszen, H. G. (2008). Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. The Lancet, 371(9613), 651-659.
• Kollaritsch, H., Kremsner, P., Wiedermann, G., & Scheiner, O. (1993). Prevention of traveler’s diarrhea with Saccharomyces boulardii. Scandinavian Journal of Gastroenterology, 28(8), 693-697.
• Kruis, W., Frič, P., Pokrotnieks, J., Lukáš, M., Fixa, B., Kaščák, M., ... & Schulze, J. (2004). Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine. Gut, 53(11), 1617-1623.
• McFarland, L. V. (2010). Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World Journal of Gastroenterology: WJG, 16(18), 2202.
• Mimura, T., Rizzello, F., Helwig, U., Poggioli, G., Schreiber, S., Talbot, I. C., ... & Kamm, M. A. (2004). Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis. Gut, 53(1), 108-114.
• Ng, S. C., Hart, A. L., Kamm, M. A., Stagg, A. J., & Knight, S. C. (2009). Mechanisms of action of probiotics: recent advances. Inflammatory Bowel Diseases, 15(2), 300-310.
• Nobaek, S., Johansson, M. L., Molin, G., Ahrné, S., & Jeppsson, B. (2000). Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. The American Journal of Gastroenterology, 95(5), 1231-1238.
• Oelschlaeger, T. A. (2010). Mechanisms of probiotic actions–A review. International Journal of Medical Microbiology, 300(1), 57-62.
• Reid, G., Charbonneau, D., Erb, J., Kochanowski, B., Beuerman, D., Poehner, R., & Bruce, A. W. (2003). Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women. FEMS Immunology & Medical Microbiology, 35(2), 131-134.
• Sanders, M. E. (2011). Impact of probiotics on colonizing microbiota of the gut. The Journal of Clinical Gastroenterology, 45, S115-S119.
• Shornikova, A. V., Casas, I. A., Mykkänen, H., Salo, E., & Vesikari, T. (1997). Bacteriotherapy with Lactobacillus reuteri in rotavirus gastroenteritis. Pediatric Infectious Disease Journal, 16(12), 1103-1107.
• Szajewska, H., & Mrukowicz, J. Z. (2005). Meta-analysis: non-pathogenic yeast Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea. Alimentary Pharmacology & Therapeutics, 22(5), 365-372.
• Vanderhoof, J. A., & Young, R. J. (2008). Probiotics in the United States. Clinical Infectious Diseases, 46(Supplement_2), S67-S72.